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Affordable Care Act

The ACA MarketplaceS

Change in February effectuated enrollment, by state, 2025-2026

How Has ACA Marketplace Enrollment Changed Across States in 2026?

ACA Marketplace enrollment fell this year in every state except New Mexico, which was the only state to fully replace the enhanced premium tax credits that expired last year with a state-funded subsidy, according to a new KFF analysis of effectuated enrollment data. The Marketplace enrollment decline—the first in seven years—follows several years of rapid enrollment growth and coincides with the end of the enhanced federal subsidies.

How Much and Why ACA Marketplace Premiums Are Going Up in 2027

ACA Marketplaces insurers are proposing a median premium increase of 15% in 2027, according to KFF’s updated analysis of 276 insurers with publicly available filings across all 50 states and the District of Columbia. This is the second consecutive year of double-digit premium hikes. Last year’s median nationwide proposed rate change was 18%, and the median finalized rate change was 20%. While this proposed rate change is lower than last year, it represents the second-highest requested rate change since 2018, as premium growth had been relatively flat in this market for several years.

About the ACA

Promotional image for KFF video How Affordable is the Affordable Care Act

Did the Affordable Care Act Make Health Care More Affordable?

The expiration of the ACA’s enhanced premium tax credits at the start of 2026, combined with rising insurer premiums, put a spotlight on health care affordability that extends beyond Marketplace enrollees. KFF’s Cynthia Cox examines the ACA’s record and the broader underlying question it raises: what’s a fair price for Americans people to pay for health care?

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  • The Flip Side of Higher Premiums: Better Coverage

    Perspective

    Time Magazine's recent cover story on health care – "Bitter Pill" by Steven Brill – has focused attention on hospital prices, especially for people paying out of their own pockets. This is not a new issue, but certainly one that deserves attention. However, what has been lost in the ensuing commentary on high hospital prices is that Brill’s article is as much about inadequate insurance, which is the reason why the patients he writes about…

  • Quick Take: Key Considerations in Evaluating the ACA Medicaid Expansion for States

    Fact Sheet

    A central goal of the Patient Protection and Affordable Care Act (ACA) is to significantly reduce the number of uninsured by providing a continuum of affordable coverage options through Medicaid and new Health Insurance Exchanges.  Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. These decisions will have substantial consequences for health coverage for the low-income population. The 3 key questions that states should consider in…

  • Federal Funding Under the Affordable Care Act

    Fact Sheet

    This fact sheet provides highlights from an analysis tracking the flow of federal Affordable Care Act funds to states as reporter in the Department of Health and Human Services grant database as well as periodic reports from HHS and the Internal Revenue Service. The analysis distinguishes between funds awarded to state and local governments (including state and local health departments and school districts) and private entities (including private employers, health centers, universities, and other community-based…

  • Consumer Choice in Health Care: How Could Reform Affect Our Choices? How Could We Make Better Choices?

    Event Date:
    Event

    The Alliance for Health Reform and the Robert Wood Johnson Foundation co-sponsored this event which brought together nationally known health policy experts for a conversation on consumer choice in health care. Panelists addressed the following questions: Why is choice of health care providers important? How much choice do we really have now? How much choice do we need? How might health reform affect our choices? In some instances, do we have too much choice? How…

  • Medicaid Eligibility, Enrollment Simplification, and Coordination under the Affordable Care Act: A Summary of CMS’s March 23, 2012 Final Rule

    Issue Brief

    This brief provides a summary of the Centers for Medicare and Medicaid Services' (CMS) March 23, 2012 final rule to implement the ACA provisions relating to Medicaid eligibility, enrollment simplification and coordination. The rule, which is effective Jan. 1, 2014, lays out procedures for states to implement the Medicaid expansion and the streamlined and integrated eligibility and enrollment system created under the ACA. Achieving this goal will require substantial process and system changes among state…

  • Study Finds Recent Slowdown in Health Spending Growth Mostly Tied to the Economy

    News Release

    Growth Expected To Move Towards Historical Levels In Coming Years As the Economy Recovers A new Kaiser Family Foundation analysis of how the economy affects the nation’s health spending concludes that the record slow growth rate of recent years stems largely from economic factors beyond the health system, with the economy explaining 77 percent of the slowdown, and more rapid growth expected in coming years if the economy strengthens as expected. Based on statistical modeling…

  • Explaining Health Care Reform: Medical Loss Ratio (MLR)

    Fact Sheet

    This fact sheet explains the Medical Loss Ratio requirement under the Affordable Care Act (ACA). The MLR provision limits the portion of premium dollars health insurers may spend on administration, marketing, and profits. Under health care reform, health insurers must publicly report the portion of premium dollars spent on health care and quality improvement and other activities in each state they operate. Insurers failing to meet the applicable standard must pay rebates to consumers and…

  • The Cost of Cancer

    Video

    This Kaiser Family Foundation documentary explores the financial consequences faced by three people, all privately insured, after being diagnosed with cancer. It was released in conjunction with a joint Kaiser/American Cancer Society report, "Spending To Survive: Cancer Patients Confront Holes in the Health Insurance System." The Cost of Cancer: Tom Olszewski Tom Olszewski, a retiree who lives in Texas, had prostate cancer but has been in remission for a decade. His medical history made it…

  • The Requirement to Buy Coverage Under the Affordable Care Act

    Other Post

    Note:  Congress eliminated the federal tax penalty for not having health insurance, effective January 1, 2019. Along with changes to the health insurance system that guarantee access to coverage to everyone regardless of pre-existing health conditions, the Affordable Care Act includes a requirement that many people be insured or pay a penalty. This simple flowchart illustrates how that requirement (sometimes known as an "individual mandate") works.     >>Download the PDF